Country situational analysis[1]

According to the 2010 UNAIDS Report on the AIDS epidemic, Swaziland has the highest HIV prevalence in the world at  25.9% at the end of 2009.

Since the first case of HIV was diagnosed in the country in 1986 the prevalence has increased dramatically from 3.9 percent in 1992 to 42.9 percent in 2004. [2]

There were 180,000 people living with HIV in Swaziland at the end of 2009.

According to the 2007 Population Census, HIV prevalence is higher among among females than males. The most affected age group is 25 -29 years old, followed by 35-39 years old.

HIV prevalence among pregnant women seeking antenatal care in government health facilities is even higher. According to the HIV Sentinel Surveillance conducted in 2008, 42% of ANC clients were HIV positive. This shows a rapid increase from 4% in 1992, to 42.2% in 2005, slight reduction to 39% in 2007 and 42% in 2008.

This pattern is confirmed by the antenatal sentinel surveillance results which shows that, over time, HIV prevalence among younger age groups has declined whereas that of older women increased as the epidemic has matured. HSS data reflects that HIV prevalence within the age group 15-19 was 32.5% in 2002 and is now 26%, while that of women aged 30-34 years was 29.6% in 2002 and has almost doubled to 49.1% by 2008.

The impact of HIV is manifested through an increase in the mortality rate and subsequent decline in life expectancy, from 60 years in 1990s to 31 years by 2007.

According to UNAIDS, there were 47,241 people living with HIV at the end of 2009. This corresponds to 59% coverage. There percentage of HIV Positive pregnant women receving antiretroviral treatment to prevent mother-to-child transmssion of HIV was 88% in the same period.

Key elements of the national response

Following the detection of the first HIV cases in 1986, the Kingdom of Swaziland established a National AIDS Programme (SNAP) in the Ministry of Health in 1989 to respond to the epidemic. One of the main objectives of the programme was to create awareness about HIV and AIDS through Information, Education and Communication. In 1998, cabinet approved a National HIV and AIDS policy. In 1999, His Majesty King Mswati III declared HIV and AIDS a National Disaster. Consequently a Crisis Management and Technical Committee (CMTC) was constituted. Since 2001, the national response has been coordinated by the National Emergency Response Council (NERCHA).

Swaziland has developed two Multisectoral National HIV and AIDS Strategic Plans (2000-05) and (2006-08), the second with a costed action plan. Both NSPs have undergone joint reviews to guide planning.

A joint review of the NSP was undertaken in 2008 and culminated in the development of the National Strategic Framework 2009-2014. The NSF, developed in 2008 through multisectoral consultation, includes reasonable targets that the country aims to achieve by 2014. The goal of the NSF is to improve the Swaziland Human Development Index, from 0.542 in 2008, to 0.55 in 2014.

Key achievements

Swaziland has developed systems to drive and manage the national response to HIV. The response is a collective effort of government, multilateral and bilateral donors, national and international non governmental organisations, community-based organisations, faith-based organizations, the private sector and organisations of people living with HIV.

The institutionalization of National Emergency Response Council on HIV/AIDS (NERCHA) as the leading organisation that coordinates the response to HIV is a major achievement. Swaziland has also formulated and launched an HIV and AIDS policy, a multisectoral National Strategic Plan (2006-08), as well as a costed action plan. The National Monitoring and Evaluation Framework has become entrenched and decentralized to the regional level to improve documenting and reporting. With these three pillars in place, Swaziland is now fully operating under the "Three Ones" principles.

Swaziland has made progress in preventing the spread of HIV through behaviour change campaigns that address issues such as multiple sexual partners and intergenerational sex. Significant progress has also been made in scaling up prevention of mother-to-child transmission since the beginning of service implementation in 2003. HIV testing among pregnant women increased from 15% in 2004 to 66% in 2006, and in 2007, 65% of the HIV-positive pregnant women received antiretroviral treatment to reduce the risk of mother-to-child transmission. However, prevention efforts continue to be hampered by limited behaviour change in the population at large.

Swaziland began the roll-out of antiretroviral treatment in 2003 and by the middle of 2007, there were 21 sites providing treatment across the country. At the end of 2007 there were 25,000 people receiving antiretroviral treatment, which is equivalent to 42% coverage.

Considerable efforts have been made to mitigate the impact of the HIV epidemic on orphans and vulnerable children by providing education, food, health, psychosocial support and shelter. The government is addressing the situation of orphans through policy and the development of the National Action Plan for Children. In 2007 it was estimated that approximately 108,000 children were orphaned and or vulnerable.[1] The ratio of school enrolment between orphans and non-orphans was 90:93 and traditional structures have been revived to care for the children in their communities.

Funding for HIV has increased considerably. The government spending on HIV and in 2006/7 accounted for 30% of the total expenditure on HIV/AIDS (USD 49 million) in the country. The remainder came from external sources, the major one being the Global Fund to Fight AIDS, Tuberculosis and Malaria

The monitoring and evaluation systems have developed and important new research data is available in the country. Swaziland has conducted its first demographic and health survey in 2006/7, carried out the national assessment on AIDS spending, modes of transmission survey, vulnerability assessment and has laid out Universal Access targets and roadmap. Stakeholders are conducting routine reporting of non-health data through the Swaziland HIV/AIDS Programme Monitoring Systems (SHAPMOS) and health-data through the health sector monitoring and evaluation system.

Key challenges

• Within MoH the inadequate monitoring of activities or interventions taking place at the community level. Timely and reliable feed back to stakeholders on M&E information products remains a challenge
• The coordination role of NERCHA is still in need of strengthening and there is lack of clarity on roles and responsibilities for partners in the HIV response
• There is inadequate skilled and experienced human resource. In addition there are inadequate strategies to mitigate staff turnover
• There are inadequate structures to effectively coordinate and monitor the response
• The challenge in program development is that not all programs are guided and informed by the National Strategy. There is also the absence of Standard operating Procedures that would include service standards and modes of operation
• There is inadequate resource available for HIV. Civil society has reflected that even where resources are provided these do not include administrative costs for the programmes they seek to implement. The majority of the civil society organisations also lack the capacity to manage funds allocated to them
• There is inadequate grant disbursement and tracking systems. There is also poor monitoring and reporting of grant utilisation
• There is inadequate development of partner coordination. There is also inadequate harmonisation of development partners program with national strategies.
• Programme sustainability remains a challenge in Swaziland as there is no donor exit strategy; inadequate community ownership and there is project funding rather than program funding

Useful links

• National Strategic Plan
• National Emergency Response Council on HIV/AIDS (NERCHA)
• Swaziland National Youth Council baseline survey for BCC strategy for HIV and AIDS prevention among youth people aged 10-30 years in Swaziland
• National AIDS Spending Assessment (NASA) 2005-2006 / 2006-2007
• PMTCT and Paediatric Care and Treatment Fact Sheet
• Modes of transmission (MOT) study 
• 2010 UNGASS Report

Contacts

UNAIDS Country Office
UCC Sophia Mukasa Monico
Fifth floor, Lilunga house
Somhlolo Street
p.o. box 261
Mbabane, Swaziland
Tel: (268 ) 404 8559
Fax: (268) 404 9931
E-mail: MukasamonicoS@unaids.org

National Emergency Response Council on HIV/AIDS (NERCHA)
Chair: Mr Derek von Wissel
po box 1937
Mbabane H 100, Swaziland
Tel +268 404 1703/8
Fax: +268 404 1692
Website: www.nercha.org.sz 

Swaziland National AIDS Programme (SNAP)
Chair: Beatrice Dlamini
Ministry of Health and Social Welfare
p.o. box 1119
Mbabane, Swaziland
Tel: +268 404 8443 or +268 404 8443, +268 4042183
Fax: +268 4042105 

The Coordinating Assembly of Non-overnmental Organisations (CANGO)
Chair: Emmanuel Ndlangamandla
p.o.box A67, Swazi Plaza
Mbabane, Swaziland
Tel: +268 404 4721
Fax: +268 404 5532
Website: www.cango.org.sz 

Swaziland National Network for People Living with HIV and AIDS (SWANNEPHA)
Chair: Thembi Nkambule
po box 4151
Mbabane, Swaziland
Tel: +268 404 2578
Fax: +268 4090197 

Swaziland Business Coalition on HIV and AIDS (BCHA)
Chair: Khosi Hlatshwako
po box 777
Mbabane, Swaziland
Tel: +268 404 0768
Fax: +268 4090051
Email: bcha@business-swaziland.com 

Swaziland Church Forum
Chair: Rev. Zwanini
po box 5924
Manzini, Swaziland
Tel: +268 505 7035
Fax: +268 5058516
Email: swazichurchforum@swazi.net

1. All epidemiological data comes from the country's 2010 UNGASS report, unless otherwise stated.
2. Source: 10^th Sentinel Surveillance report, 2006